According to Oscar Wilde, a dream without a plan is just a wish. I wholeheartedly agree. It’s important to dream, but if you don’t think about how you’re going to make those dreams a reality, then they usually remain nothing more than a dream. As mentioned previously, one of my dreams is pursuing work in private practice, doing a combination of therapy and assessment work.
Why private practice?
Simplistically, it’s all about the autonomy and flexibility. First, as a private practitioner you have a lot of say in what type of work you take on. You can therefore choose how you will balance out your case load and whether to specialise or diversify. Second, you also have a lot of input in the running of the practice. This allows for flexibility in your working hours, environment and fee structure.
So why not dive straight in?
You have to walk before you can run
Despite the perks, private practice is typically not the first port of call for an early career psychologist. With all that autonomy also comes a lot of responsibility. I’m not even going to go into the need to manage your own business. Instead, I’ll focus on the flip side of autonomy: isolation.
In private practice you rarely have the benefit of a multidisciplinary team. In fact, you may be a solo practitioner, operating entirely on your own without colleagues onsite to seek informal supervision from.
Supervision is a requirement for all psychologists. It involves regularly meeting with other psychologists of equivalent or greater seniority to review (de-identified) cases, discuss therapeutic techniques, assessment approaches, updated research and ethical dilemmas etc. The idea behind supervision is to make sure psychologists remain current with best practice and to prevent burn-out. Supervision may happen informally, e.g. dropping in on a colleague for a quick chat or, formally, as regularly scheduled meetings for ongoing professional development.
Well-developed clinical decision making skills are also essential to all psychologists, but perhaps more so to psychologists in private practice who must manage risk and complexity without the benefit of informal supervision and collaboration which are more common to public sector work places.
Clinical decision making skills allow psychologists to confidently and competently manage the complexities of providing therapy to clients at risk of harm to or from, themselves or other people; clients with multiple presenting issues (fairly common); clients presenting with less common or particularly complex difficulties and any ethically tricky situations that may arise.
Psychologists in the public sector environments typically work in multidisciplinary teams. So, ensuring clients’ safety and care is more of a collaborative process and there are generally more opportunities for informal supervision. This creates a fantastic environment for early career psychologists (graduates with up to five years experience as practicing psychologists) to hone their clinical decision making skills. This is the very reason why so many early career psychologists seek work in the public sector. Some will stay in the public sector their whole careers while others will choose to eventually move into part-time or full-time work in private practice.
The issue of endorsement
Many psychologists in private practice also have an area of endorsement. This means they’ve gone on to do further supervision to really hone their skills in a particular area e.g. clinical psychology, educational and developmental psychology or health psychology etc. This involves quite an intensive process of supervision, day to day practice as a psychologist and professional development that also assists in developing those clinical decision making skills.
Because endorsement takes a further one to years of on-the-job training beyond the years of study to register for a psychologist, it’s something a lot of early career psychologists (people with up to five years of experience working in the field) lack, at least initially. This can happen for a number of reasons. The person may not be eligible to seek an endorsement (there are specific requirements). The training can be tricky to set-up depending on your location and the availability of qualified supervisors (you need a specially trained and endorsed psychologist to supervise you in my country). Finally, if you are in the private sector, or, in the public sector but without access to an endorsement program, you may have to source one of the aforementioned supervisors externally and/or pay for their supervision.
What’s my plan?
Build up my clinical decision-making skills
- Seize opportunities to provide therapy to people with common and complex challenges in a supportive multidisciplinary environment.
Spoiler alert #1: I think I’ve found myself a bit of a ‘unicorn’ of a first job in just such an environment. Lots of diverse presentations, multidisciplinary input and support. More about all this in another post.
- Seize opportunities for assessment work that will allow me to diversify my skills e.g. varying ages, presentations, differential diagnosis
Spoiler alert #2: I actually found myself two jobs! The second is assessment based and should give me lots of scope to do all the above. Plus, it’s also in a supportive multidisciplinary team.
- As a long-term reader of Study Hacks*, working smarter not harder in building up my clinical decision-making skills is also part of my game plan. What on earth might that look like?
- Taking a month or so to identify a particular skill to work on. One that is going to be most useful for my clients and I.
- Spending a few weeks educating myself about that skill – who is it most suitable for, when should it be used, how is it used, what’s the best practice protocol?
- Spending a few weeks practicing using the skill (role-playing, adopting the skill for some first-hand experience of possible speed bumps in using and applying it).
- Introduce relevant clients to the skill, and incorporate into intervention plan if they’re on board with it.
- Seek and respond to feedback about the use of the skill from clients, team and supervisor.
Work towards endorsement
- My Plain-English definition of this process involves completing:
- Practice: 2000+ actual face-to-face or client related work hours specific to my area of endorsement
- Supervision: regularly meeting with another psychologist to chat about my approach to intervention, conduct de-identified case presentations, discuss psychological theories, ethical and professional scenarios, assessment approaches, report writing, case cross-cultural competence etc.
- Professional development: One-on-one and group supervision plus going to training workshops, reading articles and giving presentations etc.
Spoiler alert #3: One of my jobs has an in-built program to assist me in gaining my endorsement. My contract is shorter than the time required for endorsement but worst case scenario, it’s going to give me a flying start.
And that folks, is roughly where I’m at with my plan. I suspect my move into private practice will occur gradually, probably by the time I’m a mid-career psychologist (5 year + mark).
It’s important to note that this is all a very simplistic account of supervision, endorsement and work in the public and private sectors. It varies according to country, training, the employer and the psychologist. Some graduates do go straight into private practice and flourish. Perhaps because they have found a supportive team of practitioners to guide them or, because they have previous experience working in health. Different strokes for different folks as they say. Hopefully this post gives you a bit of insight into one of the pathways of many early career psychologists and why I’ve chosen this particular path myself.
*I’m a big fan of Cal Newport and his blog Study Hacks. He has some really interesting perspectives on applying the idea of working harder not smarter (and deliberate practice) in various fields. I’d strongly recommend browsing through his blog if you’ve ever had career, study or creative aspirations.